Na Seunggu, Cho Yongil, Lim Tae Ho, Kang Hyunggoo, Oh Jaehoon, Ko Byuk Sung
Department of Emergency Medicine, Hanyang University College of Medicine, Seoul, Korea.
Ann Geriatr Med Res. 2019 Sep;23(3):133-140. doi: 10.4235/agmr.19.0029. Epub 2019 Sep 27.
The purpose of this study was to identify the risk factors and causes of short-term mortality after emergency department (ED) discharge in older patients.
This population-based cohort study used nationwide health insurance claims data in Korea from 2008 to 2014. The causes of death and diagnoses of patients who died within 1 week after discharge from EDs (1-week ED death) were obtained. The risk factors for 1-week ED death were calculated using Cox proportional hazard regression analyses.
The rate of 1-week ED death was 0.5% among 133,251 individuals aged ≥65 years discharged from EDs. In multivariate analysis, the top five ED discharge diagnoses associated with an increased risk of 1-week ED death were hypotension and vascular disease (adjusted hazard ratio [aHR]=5.11; 95% confidence interval [CI], 3.03-8.63), neoplasm (aHR=4.89; 95% CI, 3.77-6.35), coronary artery disease (aHR=3.83; 95% CI, 2.73-5.39), dyspnea (aHR=3.41; 95% CI, 2.48-4.68), and respiratory disease (aHR=2.25; 95% CI, 1.73-2.92). The most common causes of 1-week ED death were neoplasm (14.8%), senility (13.8%), and cerebrovascular disease (11.7%).
Neoplasm, coronary artery disease, and respiratory disease were the discharge diagnoses associated with an increased risk of short-term mortality after ED discharge. Neoplasm was the leading cause of short-term mortality after ED discharge in older patients.
本研究旨在确定老年患者急诊科（ED）出院后短期死亡的风险因素和原因。
这项基于人群的队列研究使用了韩国2008年至2014年的全国健康保险理赔数据。获取了急诊科出院后1周内死亡患者（1周急诊死亡）的死亡原因和诊断信息。使用Cox比例风险回归分析计算1周急诊死亡的风险因素。
在133,251名年龄≥65岁的急诊科出院患者中，1周急诊死亡率为0.5%。在多变量分析中，与1周急诊死亡风险增加相关的前五位急诊科出院诊断为低血压和血管疾病（调整后风险比[aHR]=5.11；95%置信区间[CI]，3.03 - 8.63）、肿瘤（aHR=4.89；95%CI，3.77 - 6.35）、冠状动脉疾病（aHR=3.83；95%CI，2.73 - 5.39）、呼吸困难（aHR=3.41；95%CI，2.48 - 4.68）和呼吸系统疾病（aHR=2.25；95%CI，1.73 - 2.92）。1周急诊死亡的最常见原因是肿瘤（14.8%）、衰老（13.8%）和脑血管疾病（11.7%）。
肿瘤、冠状动脉疾病和呼吸系统疾病是急诊科出院后短期死亡风险增加相关的出院诊断。肿瘤是老年患者急诊科出院后短期死亡的主要原因。
